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Silvana PERRETTA

MD, PhD
Hôpitaux Universitaires de Strasbourg
Strasbourg, France
147 vidéos
324K vues
49 commentaires
9.2K J'aime
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Stress impact on healthcare workers during the COVID-19 pandemic: preliminary results of a worldwide survey-based study
During an epidemic of a novel infectious disease, many healthcare workers may suffer from stress. Fear and fatigue can be overwhelming and cause severe psychological distress such as anxiety, depression, burnout, and hostility. The recent outbreak of COVID-19 may be a major source of stress for healthcare workers. The psychological monitoring of healthcare workers during the COVID-19 outbreak is essential since it may allow for the early detection and early management of distress and deliver timely support and stress management training recommendations. The preliminary results of a survey-based study were presented during this weekly fellows meeting session jointly organized by the IHU and IRCAD France (as of May 2020).
Vidéo chirurgicale
Il y a 20 jours
237 vues
3 J'aime
0 commentaire
52:26
Stress impact on healthcare workers during the COVID-19 pandemic: preliminary results of a worldwide survey-based study
During an epidemic of a novel infectious disease, many healthcare workers may suffer from stress. Fear and fatigue can be overwhelming and cause severe psychological distress such as anxiety, depression, burnout, and hostility. The recent outbreak of COVID-19 may be a major source of stress for healthcare workers. The psychological monitoring of healthcare workers during the COVID-19 outbreak is essential since it may allow for the early detection and early management of distress and deliver timely support and stress management training recommendations. The preliminary results of a survey-based study were presented during this weekly fellows meeting session jointly organized by the IHU and IRCAD France (as of May 2020).
Endoscopic sleeve gastroplasty (ESG): live educational procedure with resolution of device-related complication
Endoscopic sleeve gastroplasty (ESG) is a novel endobariatric procedure with a mechanism of action totally different from the one used for a standard sleeve gastrectomy. An over-the-scope suturing system (OverStitch™, Apollo Endosurgery, Austin, TX) mounted on a dual-channel gastroscope (GIF- 2TH180, Olympus, Center Valley, PA) allowed to place full-thickness sutures in order to obtain gastric volume reduction and shrinking. The number of applied sutures relies on the gastric volume. Sutures are placed starting from the incisura to the fundus that is spared in a U-shaped fashion. A tissue-retracting helix device is used to grab the gastric wall. In this live educational video, Professor Silvana Perretta presented the case of a morbidly obese 38-year-old female patient with a BMI of 36.72kg/m2.
The procedure was performed with the patient under general anesthesia and carbon dioxide insufflation. An Overtube™ (Apollo Endosurgery, Austin, TX) was placed at the beginning of the procedure to protect the airways, the esophagus, and the hypopharynx. Each purse-string suture consisted of 6 to 8 full-thickness bites starting first on the anterior gastric wall, then on the greater curvature, and the posterior wall and moving backward in the opposite direction. Once completed, the suture was tied and knotted using a cinching device (EndoCinch™). During the live procedure, a complication occurred due to an excessive pressure placed on the EndoCinch™ handle which caused a break of the collar part of the cinch. The management of this complication was achieved by cutting the suture, so that the collar part of the cinch which grasped the mucosa could be detached with a grasper to allow for suture replacement. A total of 4 sutures were applied in order to obtain gastric tubulization.
Vidéo chirurgicale
Il y a 4 mois
536 vues
8 J'aime
3 commentaires
52:53
Endoscopic sleeve gastroplasty (ESG): live educational procedure with resolution of device-related complication
Endoscopic sleeve gastroplasty (ESG) is a novel endobariatric procedure with a mechanism of action totally different from the one used for a standard sleeve gastrectomy. An over-the-scope suturing system (OverStitch™, Apollo Endosurgery, Austin, TX) mounted on a dual-channel gastroscope (GIF- 2TH180, Olympus, Center Valley, PA) allowed to place full-thickness sutures in order to obtain gastric volume reduction and shrinking. The number of applied sutures relies on the gastric volume. Sutures are placed starting from the incisura to the fundus that is spared in a U-shaped fashion. A tissue-retracting helix device is used to grab the gastric wall. In this live educational video, Professor Silvana Perretta presented the case of a morbidly obese 38-year-old female patient with a BMI of 36.72kg/m2.
The procedure was performed with the patient under general anesthesia and carbon dioxide insufflation. An Overtube™ (Apollo Endosurgery, Austin, TX) was placed at the beginning of the procedure to protect the airways, the esophagus, and the hypopharynx. Each purse-string suture consisted of 6 to 8 full-thickness bites starting first on the anterior gastric wall, then on the greater curvature, and the posterior wall and moving backward in the opposite direction. Once completed, the suture was tied and knotted using a cinching device (EndoCinch™). During the live procedure, a complication occurred due to an excessive pressure placed on the EndoCinch™ handle which caused a break of the collar part of the cinch. The management of this complication was achieved by cutting the suture, so that the collar part of the cinch which grasped the mucosa could be detached with a grasper to allow for suture replacement. A total of 4 sutures were applied in order to obtain gastric tubulization.
Minimally invasive Ivor-Lewis esophagectomy for end-stage achalasia
Achalasia is the most frequent esophageal motility disorder. Although Heller myotomy is the standard treatment, achieving good results in 90 to 95% of cases, esophagectomy could be the last surgical chance to treat end-stage achalasia and might be considered if severe symptomatic (dysphagia, regurgitation), anatomical (megaesophagus) or functional (esophagus aperistalses) disorders are not relieved with a more conservative approach.
Clinical case: We present the case of a 21-year-old female patient suffering from esophageal achalasia from the age of 3. After numerous attempts to grant her a good quality of life in a conservative way, when she gets to end-stage achalasia without any benefits from endoscopic therapies, a minimally invasive Ivor-Lewis esophagectomy is put forward to her in order to relieve her symptoms. Discussion/Conclusion: Esophagectomy could be performed in patients who are fit for major surgery and present with disabling symptoms, poor quality of life, and dolichomegaesophagus unresponsive to multiple endoscopic dilatations and/or surgical myotomies.
Vidéo chirurgicale
Il y a 6 mois
1805 vues
21 J'aime
1 commentaire
13:39
Minimally invasive Ivor-Lewis esophagectomy for end-stage achalasia
Achalasia is the most frequent esophageal motility disorder. Although Heller myotomy is the standard treatment, achieving good results in 90 to 95% of cases, esophagectomy could be the last surgical chance to treat end-stage achalasia and might be considered if severe symptomatic (dysphagia, regurgitation), anatomical (megaesophagus) or functional (esophagus aperistalses) disorders are not relieved with a more conservative approach.
Clinical case: We present the case of a 21-year-old female patient suffering from esophageal achalasia from the age of 3. After numerous attempts to grant her a good quality of life in a conservative way, when she gets to end-stage achalasia without any benefits from endoscopic therapies, a minimally invasive Ivor-Lewis esophagectomy is put forward to her in order to relieve her symptoms. Discussion/Conclusion: Esophagectomy could be performed in patients who are fit for major surgery and present with disabling symptoms, poor quality of life, and dolichomegaesophagus unresponsive to multiple endoscopic dilatations and/or surgical myotomies.
Laparoscopic distal gastrectomy with Roux-en-Y reconstruction for a prepyloric lesion: a live educational procedure
This is the case of a 70-year-old patient who underwent an esophagogastroduodenoscopy for gastric pain. The exam showed a 0.5cm prepyloric ulcerated lesion with Helicobacter pylori infection. After Helicobacter pylori eradication and a CT-scan negative for secondary lesions, the patient was scheduled for a distal gastrectomy with perioperative gastroscopy.
In this original live educational video, Dr. Woo Jin Hyung describes his technique of laparoscopic distal gastrectomy with Roux-en-Y reconstruction and discusses several topics such as the comparison between laparoscopic and robotic gastrectomy, the indication for omentectomy, the choice of the surgical strategy considering the tumor location, the benefit of fluorescence in lymphatic mapping, the type of lymphadenectomy, the comparison of different energy devices and the choice of the reconstruction technique.
Vidéo chirurgicale
Il y a 6 mois
3272 vues
43 J'aime
0 commentaire
57:00
Laparoscopic distal gastrectomy with Roux-en-Y reconstruction for a prepyloric lesion: a live educational procedure
This is the case of a 70-year-old patient who underwent an esophagogastroduodenoscopy for gastric pain. The exam showed a 0.5cm prepyloric ulcerated lesion with Helicobacter pylori infection. After Helicobacter pylori eradication and a CT-scan negative for secondary lesions, the patient was scheduled for a distal gastrectomy with perioperative gastroscopy.
In this original live educational video, Dr. Woo Jin Hyung describes his technique of laparoscopic distal gastrectomy with Roux-en-Y reconstruction and discusses several topics such as the comparison between laparoscopic and robotic gastrectomy, the indication for omentectomy, the choice of the surgical strategy considering the tumor location, the benefit of fluorescence in lymphatic mapping, the type of lymphadenectomy, the comparison of different energy devices and the choice of the reconstruction technique.
Endoscopic sleeve gastroplasty (ESG): live procedure
In this live procedure, Professor Perretta performs an endoscopic sleeve gastroplasty (ESG) using the OverStitch™ endoscopic suturing system (Apollo Endosurgery) in a 50-year-old obese male patient (with a BMI of 35.3). In this particular case, preoperative esophagogastroduodenoscopy (EGD) showed a Barrett’s esophagus with positive histology for intestinal metaplasia, which is not a contraindication for this kind of endoscopic intervention. ESG is performed with the patient under general anesthesia and carbon dioxide insufflation. The supine position is preferred because it is safer than the left lateral decubitus position as it allows for a better exposure of the stomach. Sutures are placed in a U-shaped fashion from the incisura angularis to the fundus, which is spared using the OverStitch™ suturing system, mounted on a double channel Olympus scope. The system allows for the placement of durable full-thickness stitches to obtain gastric volume reduction and shrinking.
Vidéo chirurgicale
Il y a 7 mois
677 vues
10 J'aime
1 commentaire
38:23
Endoscopic sleeve gastroplasty (ESG): live procedure
In this live procedure, Professor Perretta performs an endoscopic sleeve gastroplasty (ESG) using the OverStitch™ endoscopic suturing system (Apollo Endosurgery) in a 50-year-old obese male patient (with a BMI of 35.3). In this particular case, preoperative esophagogastroduodenoscopy (EGD) showed a Barrett’s esophagus with positive histology for intestinal metaplasia, which is not a contraindication for this kind of endoscopic intervention. ESG is performed with the patient under general anesthesia and carbon dioxide insufflation. The supine position is preferred because it is safer than the left lateral decubitus position as it allows for a better exposure of the stomach. Sutures are placed in a U-shaped fashion from the incisura angularis to the fundus, which is spared using the OverStitch™ suturing system, mounted on a double channel Olympus scope. The system allows for the placement of durable full-thickness stitches to obtain gastric volume reduction and shrinking.
Endoscopic sleeve gastroplasty: live procedure
Endoscopic sleeve gastroplasty is a novel endobariatric procedure with a mechanism of action totally different from the one used for a standard sleeve gastrectomy. An over-the-scope suturing system mounted on a dual-channel Olympus® scope allowed to place full-thickness sutures in order to reduce the volume and the size of the stomach. The procedure was performed with the patient under general anesthesia and carbon dioxide insufflation. Once the Overtube™ was placed, the scope equipped with the OverStitch™ (Apollo Endosurgery®, Austin, Tex) suturing device was inserted through the stomach, and the suturing was initiated at the level of the incisura. The tissue-retracting helix device was used to grab the stomach wall, allowing for full-thickness bites. Each suture consisted of multiple sequential U-shaped bites along the anterior wall, the greater curvature, the posterior wall, and then in the opposite direction. Once completed, the suture was tied and knotted using a cinching device. Three sutures were applied in order to obtain gastric tubulization, and to spare the fundus.
Vidéo chirurgicale
Il y a 1 an
1185 vues
6 J'aime
0 commentaire
18:32
Endoscopic sleeve gastroplasty: live procedure
Endoscopic sleeve gastroplasty is a novel endobariatric procedure with a mechanism of action totally different from the one used for a standard sleeve gastrectomy. An over-the-scope suturing system mounted on a dual-channel Olympus® scope allowed to place full-thickness sutures in order to reduce the volume and the size of the stomach. The procedure was performed with the patient under general anesthesia and carbon dioxide insufflation. Once the Overtube™ was placed, the scope equipped with the OverStitch™ (Apollo Endosurgery®, Austin, Tex) suturing device was inserted through the stomach, and the suturing was initiated at the level of the incisura. The tissue-retracting helix device was used to grab the stomach wall, allowing for full-thickness bites. Each suture consisted of multiple sequential U-shaped bites along the anterior wall, the greater curvature, the posterior wall, and then in the opposite direction. Once completed, the suture was tied and knotted using a cinching device. Three sutures were applied in order to obtain gastric tubulization, and to spare the fundus.
Endoscopic internal drainage of gastric fistula after sleeve gastrectomy
Gastric fistula is a major adverse event after sleeve gastrectomy.
In this live instructional video, authors present the case of a 45-year-old woman with a complex postoperative course after sleeve gastrectomy due to a gastric leakage and a twisted stomach. The patient had already been managed with the endoscopic placement of a fully covered metal stent and a percutaneous drainage with no resolution of the fistula.
The first step of the procedure consists in the removal of a 16cm fully covered stent using a grasper. After contrast injection, the leakage and the gastric twist are visualized. Under fluoroscopic control, a 30mm pneumatic dilatation of the twist is obtained. Two double pigtail plastic stents are placed between the stomach and the abscess cavity in order to achieve internal drainage and facilitate the healing process. The percutaneous drainage will be removed one day after the procedure while the plastic stents will be removed after 3 months.
Vidéo chirurgicale
Il y a 1 an
992 vues
6 J'aime
0 commentaire
14:45
Endoscopic internal drainage of gastric fistula after sleeve gastrectomy
Gastric fistula is a major adverse event after sleeve gastrectomy.
In this live instructional video, authors present the case of a 45-year-old woman with a complex postoperative course after sleeve gastrectomy due to a gastric leakage and a twisted stomach. The patient had already been managed with the endoscopic placement of a fully covered metal stent and a percutaneous drainage with no resolution of the fistula.
The first step of the procedure consists in the removal of a 16cm fully covered stent using a grasper. After contrast injection, the leakage and the gastric twist are visualized. Under fluoroscopic control, a 30mm pneumatic dilatation of the twist is obtained. Two double pigtail plastic stents are placed between the stomach and the abscess cavity in order to achieve internal drainage and facilitate the healing process. The percutaneous drainage will be removed one day after the procedure while the plastic stents will be removed after 3 months.
EUS gastrojejunal anastomosis with HOT AXIOS® stent after Whipple pancreatectomy, filling blind loop through percutaneous transhepatic biliary drainage
A 67-year-old woman underwent a Whipple pancreatectomy for cancer one year earlier. She was readmitted to hospital for abdominal pain and subocclusion with jaundice. CT-scan showed a dilatation of the jejunal stump with associated biliary tree dilatation. Percutaneous biliary transhepatic drainage (PBTHD) was performed and a stenosis was diagnosed in the afferent loop, accountable for subocclusion and secondary jaundice. Two double pigtails were delivered by the interventional radiologist through PBTHD across the jejunal stricture without resolution of symptoms. Biliary drainage was left in place causing patient discomfort. EUS gastrojejunal anastomosis (GJA) using the HOT AXIOS® stent was attempted in order to bypass the stricture. EUS allows to find the jejunal stump, detected by mechanical staple line visualization. Additionally, the blind loop was detected as it was filled up with liquid and contrast through the PBTHD. The HOT AXIOS® stent was delivered without any complications (VIDEO). Afterwards, flow of bile and liquid was observed through the lumen-apposing metal stent (LAMS). PBTHD was immediately removed. Recovery was uneventful and the patient was discharged on a normal diet with no pain on the following day. EUS-GJA via a LAMS is a well-described technique in experts’ hands (Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Itoi T, Baron TH, Khashab MA, et al. Dig Endosc 2017;29:495-502). Special skills and techniques are necessary in order to recognize the exact small bowel loop to puncture (Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Tyberg A, Perez-Miranda M, Sanchez-Ocaña R et al. Endosc Int Open 2016;4:E276-81). In that case, we show that filling this loop using a previous transhepatic access should be considered an alternative in case of alterated anatomy. Also direct EUS transgastric injection of contrast medium in the dilated biliary tree to fill up the jejunal stump could be considered an option to perform GJA by a single operator in a single session after safely recognizing the right loop. In addition, fluoroscopy helps to detect the exact loop puncture site. In conclusion, GJA using a LAMS is feasible, safe and useful, and transhepatic injection of liquid and contrast medium helps to adequately recognize the jejunal stump after biliopancreatic surgery.
Vidéo chirurgicale
Il y a 1 an
243 vues
3 J'aime
0 commentaire
02:30
EUS gastrojejunal anastomosis with HOT AXIOS® stent after Whipple pancreatectomy, filling blind loop through percutaneous transhepatic biliary drainage
A 67-year-old woman underwent a Whipple pancreatectomy for cancer one year earlier. She was readmitted to hospital for abdominal pain and subocclusion with jaundice. CT-scan showed a dilatation of the jejunal stump with associated biliary tree dilatation. Percutaneous biliary transhepatic drainage (PBTHD) was performed and a stenosis was diagnosed in the afferent loop, accountable for subocclusion and secondary jaundice. Two double pigtails were delivered by the interventional radiologist through PBTHD across the jejunal stricture without resolution of symptoms. Biliary drainage was left in place causing patient discomfort. EUS gastrojejunal anastomosis (GJA) using the HOT AXIOS® stent was attempted in order to bypass the stricture. EUS allows to find the jejunal stump, detected by mechanical staple line visualization. Additionally, the blind loop was detected as it was filled up with liquid and contrast through the PBTHD. The HOT AXIOS® stent was delivered without any complications (VIDEO). Afterwards, flow of bile and liquid was observed through the lumen-apposing metal stent (LAMS). PBTHD was immediately removed. Recovery was uneventful and the patient was discharged on a normal diet with no pain on the following day. EUS-GJA via a LAMS is a well-described technique in experts’ hands (Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Itoi T, Baron TH, Khashab MA, et al. Dig Endosc 2017;29:495-502). Special skills and techniques are necessary in order to recognize the exact small bowel loop to puncture (Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Tyberg A, Perez-Miranda M, Sanchez-Ocaña R et al. Endosc Int Open 2016;4:E276-81). In that case, we show that filling this loop using a previous transhepatic access should be considered an alternative in case of alterated anatomy. Also direct EUS transgastric injection of contrast medium in the dilated biliary tree to fill up the jejunal stump could be considered an option to perform GJA by a single operator in a single session after safely recognizing the right loop. In addition, fluoroscopy helps to detect the exact loop puncture site. In conclusion, GJA using a LAMS is feasible, safe and useful, and transhepatic injection of liquid and contrast medium helps to adequately recognize the jejunal stump after biliopancreatic surgery.
LIVE INTERACTIVE SURGERY: robotic total gastrectomy highlighting esophagojejunal anastomosis
This video presents the case of a 71-year-old man with a BMI of 29. He was admitted to the emergency room for fatigue, severe anemia, and abdominal pain. His past medical history was significant for cardiac disease, aortic valve stenosis, and small adrenal adenoma. His past surgical history included a cholecystectomy and a prostatectomy. Work-up started with an endoscopy which showed an ulcer at the antrum, which was biopsied and showed signet cell adenocarcinoma. CT-scan confirmed the presence of a large bulky lesion and ruled out the presence of a metastatic disease. The patient was admitted again for bleeding and hematemesis and he was scheduled for a total gastrectomy. He had an exploratory laparoscopy which showed no signs of carcinomatosis. He also had preoperative chemotherapy.
This live interactive video demonstrates a robotic total gastrectomy for gastric cancer, including a stepwise lymphadenectomy and precise thorough description of esophagojejunal anastomosis.
Vidéo chirurgicale
Il y a 1 an
3379 vues
19 J'aime
0 commentaire
04:27
LIVE INTERACTIVE SURGERY: robotic total gastrectomy highlighting esophagojejunal anastomosis
This video presents the case of a 71-year-old man with a BMI of 29. He was admitted to the emergency room for fatigue, severe anemia, and abdominal pain. His past medical history was significant for cardiac disease, aortic valve stenosis, and small adrenal adenoma. His past surgical history included a cholecystectomy and a prostatectomy. Work-up started with an endoscopy which showed an ulcer at the antrum, which was biopsied and showed signet cell adenocarcinoma. CT-scan confirmed the presence of a large bulky lesion and ruled out the presence of a metastatic disease. The patient was admitted again for bleeding and hematemesis and he was scheduled for a total gastrectomy. He had an exploratory laparoscopy which showed no signs of carcinomatosis. He also had preoperative chemotherapy.
This live interactive video demonstrates a robotic total gastrectomy for gastric cancer, including a stepwise lymphadenectomy and precise thorough description of esophagojejunal anastomosis.